Changing models of public antenatal care in Australia: is current practice meeting the needs of vulnerable populations?

OBJECTIVE: to investigate women's views and experiences of public antenatal care.

DESIGN: population-based survey in two states.

SETTING: South Australia and Victoria, Australia.

PARTICIPANTS: 4366 women surveyed at 5-6 months post partum.

FINDINGS: of 8468 eligible women mailed the survey, 52% returned completed questionnaires. Fifty-seven per cent of women (2496/4339) received public antenatal care. Of these, half attended a GP for some/all antenatal visits, 38% attended a public hospital clinic or midwives clinic, and 12% had primary midwife care, mostly in a midwifery group practice. Women with complex needs - young women, those experiencing multiple social health problems, women of non-English speaking background, and women at higher risk of complications in pregnancy - were the least likely to say that care met their needs. Women attending a GP or midwife as a primary caregiver were the most positive about their antenatal care: 69% and 74% respectively describing their antenatal care as 'very good'. Women attending a standard public hospital clinic were the least positive about their antenatal care with only 48% rating their care as 'very good'. Women enroling in GP shared care or attending a midwives clinic at a public hospital gave intermediate ratings.

CONCLUSION AND IMPLICATIONS FOR PRACTICE: Models of public antenatal care involving a designated lead primary caregiver (GP or midwife) came closest to meeting women's need for information, individualised care and support.